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Acupuncture and IVF

Acupuncture and IVF – How might it work?

There are several by which acupuncture could influence the results of In vitro Fertilization – IVF. Acupuncture has been shown in some studies to affect the levels of pituitary and ovarian hormones. Electro-acupuncture may help improve blood flow in the uterine arteries of infertile women.

The most immediate possible effect is that acupuncture served to "relax" the uterus around the time of the transfer. Several studies have shown that the uterus has contractions and that these contractions could cause expulsion of the transferred IVF embryos. If the contractions were reduced by acupuncture then that could be a mechanism for an improvement in IVF pregnancy rate.

However, researchers performing a study on 164 IVF patients found that acupuncture did not reduce uterine contractions. Furthermore, implantation of the embryos into the uterine lining does not occur for two to five days after embryo transfer depending upon when the embryos were transferred. It is unknown whether the effect of acupuncture performed on the day embryo transfer would last until the day of embryo implantation or longer.

Many patients have been told that they should use acupuncture for IVF because they will respond better to medication, get more eggs, get healthier eggs, or get higher pregnancy rates. Many women with specific problems such as high FSH levels or miscarriages have been promised that acupuncture will cure all these problems. To date, however, there is no objective data that backs up these claims.

As of early 2008, there have been a few studies looking at whether acupuncture influences the outcome of IVF cycles. I have reviewed most of these studies below. A new IVF and acupuncture study , published in February 2008, combined the results of many of these smaller studies. they concluded that it would take 10 IVF embryo transfers to obtain one additional live birth

Acupuncture and IVF – Study Number 1

The first published study, which received a great deal of attention, was conducted by Paulus and colleagues. Although this study was well designed, it looked at a very specific group of patients. The results may not be applicable to other patient groups.

Acupuncture IVF Patient Groups- Study Number 1

The study looked at 160 women aged 21 to 43. Over half the couples were being treated for IVF because of male factor. One fourth had blocked tubes. This is an important consideration since three fourths of the patients would not be expected to have any hormonal abnormalities or uterine issues.

Another requirement for entry into the study was that only couples "with good embryo quality" were eligible. This is an extremely important point. Based on the results of this study, we do not have any idea whether acupuncture would work for couples who do not have good embryo quality.

Acupuncture and IVF Treatment – Study Number 1

In this study, IVF patients received acupuncture 25 minutes before and 25 minutes after the embryo transfer. No patients received acupuncture before or during treatment with fertility medications. Thus, we do not know if acupuncture would have had any effect on improving the number of eggs or any influence in the preparation of the uterine lining.

The acupuncture points chosen for the study were supposed to result in:

Better blood perfusion and "energy" in the uterus

Sedation of the patient

"Stabilization" of the endocrine system

Acupuncture and IVF Pregnancy Rates and Results – Study Number 1

In this study, IVF patients who had acupuncture had a 42% pregnancy rate. IVF patients who did not have acupuncture had a 26% rate.

There was no difference between the two groups in the thickness of the uterine lining or indexes of blood flow through the uterine arteries either before or after the embryo transfer. Hormone levels were not measured during this study.

One of the criticisms of this study is that the results could be due to the placebo effect. To counter these criticisms, one year after publishing the original study, the authors presented a placebo-controlled study at the annual meeting of the European Society for Human Reproduction and Embryology. Two hundred patients with good embryo quality were randomized to receive either real or sham acupuncture for 25 minutes before and after ET. There were clinical pregnancies in 43% of the real and 37% of the sham acupuncture patients. Statistical analysis of the results determined there was no significant difference between the groups. In other words, in this study, conducted by the same investigators and performed in the same way as the original study, acupuncture was not found to improve pregnancy rates.

Conclusions from Study Number 1

When the first and second parts of this study conducted by these investigators are taken into account, it would appear that performing acupuncture immediately before and after the embryos transfer may not result in a higher chance for pregnancy.

Acupuncture and IVF – Study Number 2

Prior to beginning their study, the doctors who conducted acupuncture study number 2 performed a “power analysis”. This means they used some of the data from the Paulus study above as well as the pregnancy rate results from their own clinic to calculate, ahead of time, the number of patients they would need to study in order to prove that acupuncture either works or doesn’t work. They determined that to find a difference in the clinical pregnancy rate of 11% between no acupuncture (the control group) and acupuncture (the treatment group) they would require approximately 100 patients in a control group and 200 patients in the acupuncture groups.

Acupuncture and IVF Treatment Protocol- Study Number 2

The study was conducted over a period of 16 months. During that time, about 1000 couples underwent in vitro fertilization at their center. Of these, 300 couples agreed to participate in the study and were randomized to one of three groups on the day of egg retrieval. After randomization, 27 patients were excluded for various reasons. Of the remaining 273 patients, 87 were allocated to no acupuncture (control group), 95 to acupuncture on the day of embryo transfer, and 91 to receive acupuncture on the day of ET and again 2 days later.

Acupuncture IVF Pregnancy Rates and Results – Study Number 2

There was no difference between the three groups in the number of eggs retrieved or the number of embryos available to transfer to the uterus.

The ongoing pregnancy rate was higher in both of the acupuncture groups compared to the control group. The ongoing pregnancy rate in the group which received acupuncture once was 36%, in the group that received acupuncture twice, the rate was 33% and in the group that did not receive acupuncture at all it was 22%. Statistical analysis was performed to determine whether these results might have been due to random chance. The analysis determined that the improvement in pregnancy rates in the single acupuncture group was unlikely to be due to chance but that the improvement in the double acupuncture group may have been due to chance.

Interestingly, the miscarriage rate in the group that received acupuncture twice was 33%. This is higher than the miscarriage rate in the group that had acupuncture once 21% or the control group — 15%. Statistical analysis showed that these results might have occurred by random chance however.

The results of this study are somewhat confusing. If acupuncture was beneficial in increasing pregnancy rates, then why weren’t two acupuncture sessions better than one? What was the reason for the seemingly higher miscarriage rate in the group that received acupuncture twice?

Acupuncture and IVF – Study Number 3

In this third acupuncture study, a total of 225 infertile patients were included: 116 women were randomized into group I (the study group), and 109 women were randomized into group II (the control group). The physician who performed the embryo transfer was not aware of which couples were in which group. On the day of embryo transfer, the patients in the study group received acupuncture according to the principles of traditional Chinese medicine. At the same time, a special Chinese medical drug (the seed of Caryophyllaceae) was placed on the patient’s ear. The seeds remained in place for 2 days and were pressed twice daily for 10 minutes. Three days after the embryo transfer, the patients received a second acupuncture treatment. In addition, the same ear points were pressed at the opposite ear twice daily. The seeds were removed after 2 days.

The control group received placebo or phony acupuncture. As in the treatment group, patients received phony acupuncture treatment for 30 minutes. The phony acupuncture treatment was repeated three days after the embryo transfer. Equal numbers of needles were applied to the study and control groups. The placebo acupuncture treatment was designed not to influence fertility.

Acupuncture and IVF Pregnancy Rates and Results – Study Number 3

Both groups were similar in terms of age, weight, duration of infertility, cause of infertility, and number of previous IVF attempts. No differences were found in the specifics of the ovarian stimulation, the number of eggs retrieved, the fertilization rate, or the number of embryos transferred.

The success rates were looked at in a few ways. The implantation rate is the number of pregnancies produced divided by the number of embryos transferred. The real acupuncture group had an implantation rate of 14.2% whereas the phony acupuncture group’s implantation rate was only 5.9%. The ongoing pregnancy rate was 28.4% in the real acupuncture group compared to 13.8% in the phone group.

Acupuncture and IVF – Conclusions from Study Number 3

This study introduced a number of variables that make it difficult to interpret the results. First, a Chinese medicine was administered in addition to the acupuncture. There is no way to determine, therefore, whether the results were the result of the acupuncture or the medicine.

The “control group” had acupuncture performed at sites that were not thought to improve fertility. It is possible however, that these sites actually had a negative effect. The way the study was designed, there is no way to determine which is correct.

Acupuncture and IVF – Study Number 4

This next acupuncture and in vitro fertilization study subjected the patients to three acupuncture treatment sessions. The first took place before the egg retrieval on the 9th day of ovarian stimulation with fertility drugs, and the second and third acupuncture treatments were performed immediately before and after the embryo transfer. Women were randomly allocated to receive treatment with acupuncture or with noninvasive “sham” (placebo or phony) acupuncture.

Acupuncture IVF Patient Groups- Study Number 4

Subjects were randomly allocated to a study group by selection of sealed envelopes. Women were allocated to receive treatment with acupuncture or with noninvasive sham acupuncture.

Acupuncture and IVF Treatment Pregnancy Rates – Study Number 4

Of the 228 subjects randomized, 15% were unable to complete the treatment protocol because their IVF cycle was cancelled prior to the embryo transfer. No difference in the grading of embryos was found between groups. The pregnancy rate, defined as fetal heart rate on ultrasound scan, was 31% in the acupuncture group and 23% in the control group. Statistical analysis demonstrated that the difference seen was likely the result of chance and not the acupuncture itself.

The pregnancy rate was also not found to differ between groups if the women studies were under age 35.

No difference was found between groups for other study endpoints: number of eggs retrieved, fertilization rate or number of embryos transferred.

To examine whether the attempts to conceal from the patients the treatments they were receiving was successful, subjects were asked which group they thought they had been allocated to. Twenty-six subjects (11%) correctly guessed which group they were in. 16 subjects were in the treatment group and 10 were in the control group.

Acupuncture and IVF — Conclusions from Study Number 4

This study, which appeared to have a valid control group, could not demonstrate a benefit in terms of better pregnancy rates when acupuncture was used.

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